AUTHORIZED APPLIANCE PARTS
P.O. BOX 2799, BLOOMINGTON, IL
BY MAIL: Simply fill out this form and mail to address above. Please include day and evening phone numbers
2/01
TO ORDER BY PHONE, PLEASE CALL:
S
O
L
D
T
O
NAME
ADDRESS (street address needed for UPS)
CITY | STATE | ZIP |
DAYTIME PHONE |
| EVENING PHONE |
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FAX |
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S
H
I
P
T
O
NAME
ADDRESS (street address needed for UPS)
CITY | STATE | ZIP |
DAYTIME PHONE |
| EVENING PHONE |
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FAX |
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IMPORTANT: Be sure to include your model, type, and serial number. These numbers may be found on the rating plate.
MODEL NUMBER: ____________________ | TYPE: ____________ | SERIAL NUMBER: ______________________ | ||||||
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| Part Number | Qty. | Price (USD) |
| Total | |
ACCESSORIES/TOOLS: |
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Filter Assembly |
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| 61518 |
| 1.99 |
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Filter Support |
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| 61508 |
| .99 |
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Bristle Brush |
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| 61511 |
| .99 |
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Dust Cup Assembly |
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| 61519 |
| 6.99 |
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Front Wheel & Shaft - package of 2 each |
| 61514 |
| 2.49 |
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Crevice Tool |
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| 61509 |
| 1.49 |
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Method of Payment:
Check or Money Order (payable to Authorized Appliance Parts)
MasterCard |
Exp. Date: |
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| Year | ||
Signature (full name as shown on acct.) _____________________________________________
TOTAL (prices subject to change without notice)
TAX (add state tax & local taxes as required by law)
POSTAGE & HANDLING CHARGE (within U.S.A.) | $5.50 |
TOTAL (please no cash or C.O.D.s)
Printed in China
71340
